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GMF Health is now part of HBF Health Insurance. Browse cover options. Existing members, recent changes explained.

What is a Medical Gap?

The Medical Gap is the difference between the Medicare Benefit Schedule (MBS) fee set by the Federal Government, and the amount Medical Practitioners charge private patients when they are admitted to a hospital or day hospital facility.

Some doctors and specialists only charge the MBS fee. In these cases, there is no Medical Gap to pay because Medicare covers 75% of the cost of treatment, and the remainder is covered by private hospital cover (provided that the treatment is not specifically excluded from your level of cover).

However, many doctors and specialists charge more than the MBS fee. It is the amount above the MBS fee that is known as the Medical Gap. Having private hospital insurance means that you may be able to substantially reduce this gap, and in some cases avoid having to pay the gap at all.